Smoking history and symptoms

The primary method of diagnosing tobacco use is through the confidential interview or history. Symptoms of a chronic smokeer include fatigue, dyspnea on exertion, snoring and sleep apnea, retrosternal discomfort, heart burn, weight loss, breathlessness, sputum production and chest pain, leg pain, weight loss, loss of appetite and hemoptysis.

The primary method of diagnosing tobacco use is through the confidential interview. The following questions are helpful to identify patients using tobacco and screen the severity of use:^[1]

• Do any of your friends use tobacco? Do you friends use e-cigarettes, e-hookah, or vape? (This question may help open the conversation, especially for younger adolescents.)
• Have you ever tried a tobacco product? Which tobacco products have you used? Have you tried an e-cigarette, e-hookah, or vape?
• How many times have you tried (name of tobacco product)?
• How often do you use (name of tobacco product)?
• Patients must be enquired regarding any symptoms of anxiety and depression

Severity assessment of tobacco use:

• Clinicians must assess the cigarette smoking dependence through use of the Hooked on Nicotine Checklist or the modified Fagerstrom Test for Nicotine Dependence (both available through the Alcohol and Drug Abuse Institute-University of Washington Library http://lib.adai.washington.edu/).

Symptoms of chronic nicotine use include:

• Fatigue
• Dyspnea on exertion
• Snoring and sleep apnea
• Retrosternal discomfort
• Heart burn
• Weight loss
• Patients with bronchitis present with fever, breathlessness, sputum production and chest pain.
• Patients with peripheral vascular disease present with claudication pain.
• Patients with lung cancer present with weight loss, loss of appetite, hemoptysis and sputum production.

Symptoms of nicotine withdrawal include:

• Increased appetite
• Weight gain
• Dysphoria or depression
• Difficulty falling asleep
• Irritability
• Anxiety
• Difficulty concentrating
• Restlessness

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